Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, pre-certification, referrals, and claims/encounter data filing may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the client's specific MCO for details.
This notice serves as a clarification to an article titled “Procedure Code Addition and Update for Coronavirus (COVID-19),” which was published on this website on July 10, 2020.
Procedure code S8301 may be reported for any encounter in which personal protective equipment (PPE) above and beyond normal protocol is required to safely treat a patient with or without a diagnosis of COVID-19. For example, if under normal circumstances gloves alone are sufficient for the encounter, any additional PPE required is considered “above and beyond normal protocol.” Commonly used supplies for any given service/procedure is not considered “above and beyond normal protocol.”
When billing for procedure code S8301, providers must submit the appropriate receipts/invoices with a paper claim as part of the regular claims process. Standard claims filing deadlines will apply.
Procedure code S8301 is reimbursed in accordance with 1 TAC §355.8023 and is subject to manual pricing at the documented MSRP less 18 percent or the provider’s documented invoice cost. Procedure code S8301 does not require prior authorization.
Providers can refer to the current Texas Medicaid Provider Procedures Manual, section 2.4.2 “Reimbursement” for more information.
For more information, call the TMHP Contact Center at 800-925-9126.